Provider Demographics
NPI:1104004415
Name:NOLL, LUCELLE MARGARET
Entity Type:Individual
Prefix:
First Name:LUCELLE
Middle Name:MARGARET
Last Name:NOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LUCELLE
Other - Middle Name:MARGARET
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27885 170TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-9444
Mailing Address - Country:US
Mailing Address - Phone:218-281-3506
Mailing Address - Fax:218-281-3015
Practice Address - Street 1:27885 170TH AVE SW
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-9444
Practice Address - Country:US
Practice Address - Phone:218-281-3506
Practice Address - Fax:218-281-3015
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant